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Exfoliative Keratolysis

What is Exfoliative Keratolysis?

Exfoliative Keratolysis often called “keratolysis exfoliativa” or “focal palmar” peeling is an integumentary disease wherein peeling of the skin occurs, it usually affects the distal parts of the fingers and the palmar toes. The disease is thought about as seasonal as this usually affects young adults during summer. Although there has not been any studies to confirm it, it is very rampant around that time of the year.

Skin peeling happens when the outer layer of the skin called as epidermis; which is made up of keratin, breaks down, loses its strength and exfoliates. As a result, the skin begins to shred. Because of this prevalent condition, the disease is sometimes mistaken for “eczema”. The difference between the two is that the former only peels and shreds while the latter has an accompanying ‘itchy feeling” on the skin. When it comes to the blisters, the former is usually air filled while the latter tend to be fluid filled. Eczema can be painful too unlike the aforementioned which doesn’t have accompanying pain. The latter isn’t seasonal as well and happens all year round and is also common for people who have skin asthma.

Picture 1: Fingers affected with Exfoliative Keratolysis

Symptoms of Exfoliative Keratolysis

One of the primary signs of the disease starts with bursting blisters, scales that peel and are circular in shape, and areas appear to be cracked and peeled too. However, this is not generally itchy in contrast to eczema. Another sign of the condition is the appearance of skin tags. It is a result when blisters concentrated on the palm peel off and split making it look like it is shredding. As they do so, new skin is born out of the process. However, the condition is recurrent sometime after the skin returns to normal. The same also occurs when the condition affects the palm or the soles of the feet.

It is important to note that prolonged healing occurs when the blisters centers on the base of the fingers due to consistent shredding and peeling of the skin. Because of this, the skin’s ability to heal is compromised. Additionally, numbing sensations of the skin are marked accompanied by hardening of the skin as well.


There is no definitive cause for Exfoliative Keratolysis, however, there are a couple of situations that make someone susceptible to accumulating the disease.

  • Firstly, exposure to allergens can cause the condition to develop as it can sometimes be a result of an allergic reaction. The example can be best explained by skin asthma. It is triggered by allergic reactions to substances, food or even air.
  • Secondly, genetic predisposition may also expose someone to this condition as certain environmental or external factors can trigger the disease to develop.
  • Thirdly, detergents, irritating soaps and sometimes solvents can cultivate exfoliation reactions.
  • Fourthly, although unproven, medical researchers believe that extremely hot climate during summer increases episodes of perspiration. This situation is linked to destruction of keratin layers in the epidermis resulting to unwarranted skin exfoliation.
  • Fifthly, prolonged exposure to salt water and the bacteria present on sea creatures contributes to skin peeling. This is common among fishermen but no significant evidence has been correlated to this incident.
  • Lastly, stress can be an important triggering factor for Exfoliative Keratolysis. It can activate the condition or worsen it if one is already afflicted by it.

Exfoliative Keratolysis Treatment

Picture 2: Palm with Exfoliative Keratolysis

The best way to treat the condition is to avoid the causative factors. For example, avoiding irritants such as soap, detergents and solvents can really prevent the condition from recurring again. Another is to be extra careful during outbreaks particularly summer season. When the weather is so hot, it can cause skin peeling that may eventually lead to lamellar dyshidrosis and to prevent that it is strongly advised to apply lotion in the sensitive prone areas such as the fingers and the feet. It is also recommended to keep the hands clean to keep the bacteria away from getting inside the cracks. Getting oneself rehydrated is a good condition as well as well hydrated cells aren’t easily affected by extremely hot weather conditions.

In addition to the above, topical use of emollients that contain urea, silicone and lactic acid is also beneficial in keeping the skin’s layers healthy because the disease usually attacks the outermost layer of the skin therefore it is best to make sure this is protected.

Use of topical steroids and cortisone cream and even increased levels of prednisone is also effective in treating the problem.

Natural Remedies

  • Oatmeal bath – this gains improvement when practiced daily
    Use of anti-inflammatory herbs like ginger, chamomile, clove, licorice
  • Taking daily Vitamin supplements as weakened immune system predisposes someone to the disorder
  • Fresh aloe vera gel and cucumber gel
  • Honey application over the peeled area
  • Mint application on affected area; mint contains healing properties and has moisturizing effects as well
  • Pineapple juice applied over to damaged skin
  • Eating protein rich foods such as meat, liver, carrots as they aid in cell repair
  • Drinking apple cider vinegar pills and olive extracts
  • Frequent cutting of fingernails and toenails to maintain hygiene
  • Avoidance of eating egg as it is a known allergen as well as crustaceans or seafoods
  • Eating peanut butter ( works for some )

Another medical approach to treat the disorder is photochemotherapy (PUVA). This approach has been present since 1976 and uses ultraviolet rays to treat the condition. It also involves the use of Psoralens which are compounds found in plants that also includes methoxsalen, 5-methoxypsoralen and trisoralen. This method has been used by Egyptians thousands of years ago to treat severe integumentary disorders.

There are different ways to do the treatment. The following methods are Listed below:

Whole Body PUVA

Oral – for this method, methoxsalen capsules are ingested orally a few hours before the procedure usually 2-3 hours

Bathwater PUVA – in this scenario the patient soaks himself to a bath tub with water mixed with psoralen solution. This is usually repeated 2-3 rows in a week.

For this procedure, the patient is contained in a cabinet consisting 24 UVA fluorescent bulbs. They are also advised to take on protective goggles to shield the eyes from being exposed to the harmful radiation. In addition, the patient is advised to wear minimal clothing sometimes just underwear so the body can be openly exposed. However, there are situations that local approach is utilized.

Localised PUVA

For this scenario, only the affected hands or feet are soaked in methoxsalen solution for half an hour before it is being exposed to UVA rays. The procedure runs from a minimum of one minute to a maximum of 30 minutes depending on the patient’s tolerance. Fans and air conditioning equipments are readily available to neutralize the heating process as lengthened periods of treatment tend to get very hot sometimes.

Topical – psoralen emollients such as gels or lotions are typically applied to the affected areas for 10 minutes before skin is exposed to UVA

Psoralens – Another way to treat the condition is the use of PUVB ( this is a mixture of psoralens and short wave ultraviolet radiation). But this method is rarely recommended as psoralen activation works best with UVA.

As use of PUVA can be costly sometimes, some dermatologists recommend exposure to sunlight as it is safer compared to methoxsalen. However, one has to take psoralen by mouth or apply topical psoralen before exposing oneself to the sun as it is difficult to calibrate the correct amount of exposure.

Although effective, PUVA treatment can also have some negative side effects such as:

  • Burning – usually occurs 24-72 hours post treatment
  • Skin aging and cancer – extensive and lengthened therapies predisposes someone to skin cancer
  • Itching – this is common after treatment but can be relieved by antihistamines or moisturizers
  • Eye damage – cataracts and keratitis is a possible when protective goggles aren’t worn during treatment
  • Tanning – this is common the most common yet it usually runs for a couple of months but skin can still burn easily

How long does Exfoliative Keratolysis last?

As previously mentioned above, there is no definitive cure for this disorder. And because of that, the condition is recurrent as the root problem of the disorder isn’t directly addressed. Although treatments are available, it is more of palliative. Meaning, the signs are symptoms are treated but the underlying cause is not addressed. Once the scales and the redness heals, the condition hibernates. However, after a few months or sometimes even after a few weeks the condition recurs again. In cases like this, it would be recommended to consult a physician for extensive treatment and care but their management can only be limited too as it is best to treat the condition on its early episodes. Most of the time, when a patient walks in for help, the disease has already worsened and has repeatedly recurred. As a result, the disorder is already difficult to treat.

Pictures of Exfoliative Keratolysis

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